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Zhang et al.

Figure 2. Funnel plot with Egger's test of all included studies.

improvement after MAIT, and a 0.78-point improvement after laser. On acoustic rhinometry, a 0.40 increase in cross-sectional area (CSA) was seen after RFA and 1.94-point increase in CSA after MAIT. For nasal air fl ow results, a 2.55 cm 3 /sec improvement was seen after RFA, and 0.90 cm 3 /sec improvement after laser (Table 2). AR Versus NAR Outcomes Three studies analyzing RFA reported on VAS nasal obstruc tion using allergic rhinitis and non-allergic rhinitis sub groups. After treatment with RFA, similar mean differences were seen for both AR and NAR groups post-operatively (4.23 [3.86 – 4.61] vs 4.63 [4.18 – 5.07], both groups with p < 0.0001) (Figure 4). Follow-up Time RFA Versus MAIT Results of VAS obstruction for all RFA and MAIT studies were strati fi ed by length of follow-up. For RFA, earlier time points (3 – 6 months and 6 – 8 months follow-up) showed a signi fi cant difference in VAS obstruction com pared to lengthier follow-up at 1 – 5 years. While post procedure results were signi fi cantly improved from baseline at all time points, a progressive recurrence of nasal obstruc tion symptoms was observed with lengthier follow-up for RFA (VAS weighted mean increased from 3.02 to 3.14 to 3.68) (Figure 5). For MAIT, a signi fi cant difference was seen when com paring 3 – 6 months of follow-up to 1 – 5 years of follow-up, with worse obstruction ratings at lengthier follow-up time (VAS weighted mean 1.68 to 2.53) (Figure 5).

94.9%) and 5 studies performed concurrent out-fracture. The median follow-up time was 6 months (mean 9.6 months, range 1 week – 7.8 years). The primary outcome data (ie, VAS scores and physiolog ical nasal air fl ow outcomes) are demonstrated in Table 2, and outcomes from studies directly comparing two different tech niques is shown in Figure 3. Patient-Reported Outcomes Table 2 shows the mean difference between baseline and post operative VAS (0 – 10cm) for nasal obstruction, rhinorrhea, sneez ing, and nasal itching. Random effects modelling demonstrated signi fi cant improvement on VAS obstruction using all tech niques, including RFA, MAIT, electrocautery, laser, and SMR/ turbinectomy. MAIT appears to have resulted in the greatest mean difference between baseline and post-op VAS obstruction (with a 5.24-point improvement) and rhinorrhea (3.79-point improvement post-operatively). For studies directly comparing two techniques, greater improvement in nasal obstruction was seen for patients treated by MAIT compared to RFA (MD 4.81 vs 2.64), however this was not statistically signi fi cant (p = 0.09) (Figure 3A). Similar mean differences in VAS obstruction were achieved when directly comparing RFA to electrocautery and RFA to SMR/turbinectomy (Table 3). Additionally, data was available for VAS sneezing and nasal itching ratings following RFA, demonstrating a 2.09-point improvement in sneezing and a 1.59-point improvement in nasal itching. Physiologic Outcomes Random effects modelling demonstrated a 1.35-point improvement in nasal resistance after RFA, a 1.80-point